METHODS: Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract stages, followed by full-text appraisal, data extraction, and synthesis of eligible studies. Studies were extracted to capture details of the mhealth tools used, the service issues addressed, the study design, and the outcomes evaluated. We then mapped the included studies using the 20 sub-strategies of the WHO Framework on Integrated People-Centred Health Services (IPCHS); as well as with the RE-AIM (Reach, effectiveness, adoption, implementation and maintenance) framework, to understand how studies implemented and evaluated interventions.
RESULTS: We identified 39 studies, predominantly from Australia (n = 16), China (n = 7), Malaysia (n = 4) and New Zealand (n = 4), and little from low income countries. The mHealth modalities included text messaging, voice and video communication, mobile applications and devices (point-of-care, GPS, and Bluetooth). Health issues addressed included: medication adherence, smoking cessation, cardiovascular disease, heart failure, asthma, diabetes, and lifestyle activities respectively. Almost all were community-based and focused on service issues; only half were disease-specific. mHealth facilitated integrated IPCHS by: enabling citizens and communities to bypass gatekeepers and directly access services; increasing affordability and accessibility of services; strengthening governance over the access, use, safety and quality of clinical care; enabling scheduling and navigation of services; transitioning patients and caregivers between care sectors; and enabling the evaluation of safety and quality outcomes for systemic improvement. Evaluations of mHealth interventions did not always report the underlying theories. They predominantly reported cognitive/behavioural changes rather than patient outcomes. The utility of mHealth to support and improve IPCHS was evident. However, IPCHS strategy 2 (participatory governance and accountability) was addressed least frequently. Implementation was evaluated in regard to reach (n = 30), effectiveness (n = 24); adoption (n = 5), implementation (n = 9), and maintenance (n = 1).
CONCLUSIONS: mHealth can transition disease-centred services towards people-centred services. Critical appraisal of studies highlighted methodological issues, raising doubts about validity. The limited evidence for large-scale implementation and international variation in reporting of mHealth practice, modalities used, and health domains addressed requires capacity building. Information-enhanced implementation and evaluation of IPCHS, particularly for participatory governance and accountability, is also important.
METHODS: This is a prospective cohort study on offshore platforms in the United States, Malaysia, and the United Kingdom. Emergency evacuation rates were compared between locations with telemedicine (United States) and 2 control groups without telemedicine (Malaysia, United Kingdom).
RESULTS: Three hundred eighty-four cases in the telemedicine group and 261 cases in the control groups were included. The odds (adjusted and unadjusted) of medical evacuation were significantly higher for assets without telemedicine, contractors, and age older than 60 years. Analysis indicated a shift from emergency evacuation to routine transport for the telemedicine group.
CONCLUSIONS: Telemedicine reduces emergency medical evacuations from offshore installations. This reduction is likely due to an increased capacity for transforming emergency care into routine care at the offshore location.
METHODS: A systematic search from the inception till May 31, 2021, in the MEDLINE, Embase, and PubMed databases was conducted, and 16 randomized controlled trials were included in the analysis.
RESULTS: The results showed significant benefits on glycosylated hemoglobin (HbA1c) (mean difference -0.24%; 95% confidence interval [CI]: -0.44, -0.05; p = 0.01), postprandial blood glucose (-2.91 mmol/L; 95% CI: -4.78, -1.03; p = 0.002), and triglycerides (-0.09 mmol/L; 95% CI: -0.17, -0.02; p = 0.010), but not on low-density lipoprotein cholesterol (-0.06 mmol/L; 95% CI: -0.14, 0.02; p = 0.170), high-density lipoprotein cholesterol (0.05 mmol/L; 95% CI: -0.03, 0.13; p = 0.220), and blood pressure (systolic blood pressure -0.82 mm Hg; 95% CI: -4.65, 3.00; p = 0.670; diastolic blood pressure -1.71 mmHg; 95% CI: -3.71, 0.29; p = 0.090).
CONCLUSIONS: Among older adults with T2DM, mHealth interventions were associated with improved cardiometabolic outcomes versus usual care. Its efficacy can be improved in the future as the current stage of mHealth development is at its infancy. Addressing barriers such as technological frustrations may help strategize approaches to further increase the uptake and efficacy of mHealth interventions among older adults with T2DM.